PROCEDURE 18 - Accident/Illness Reporting and Recording. Table of Contents

PROCEDURE 18 - Accident/Illness Reporting and Recording Table of Contents Page Synopsis...18-ii Accident/illness Reporting and Recording Checklist...18-iii 18 ACCIDENT/ILLNESS REPORTING AND RECORDING...18-1 18.1 Purpose and Scope...18-1 18.2 Definitions...18-2 18.3 Procedure...18-2 18.4 Responsibilities...18-7 18.5 References... 18-9 18.6 Attachments...18-9 ATTACHMENT A...18-A-1 Safety Incident Rating Details Description...18-A-1 ATTACHMENT B...18-B-1 Form CD-351 Report of Possible Safety/Health Hazard...18-B-1 ATTACHMENT C...18-C-1 Form CA-1 Federal Employees Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation...18-C-1 ATTACHMENT D...18-D-1 Form CA-2 Notice of Occupational Disease and Claim for Compensation...18-D-1 ATTACHMENT E... 18-E-1 Form SF-91 Operator s Report of Motor Vehicle Accident... 18-E-1 ATTACHMENT F... 18-F-1 Form SF-94 Statement of Witness... 18-F-1 ATTACHMENT G...18-G-1 Form CA-16 Authorization for Examination and/or Treatment...18-G-1 ATTACHMENT H...18-H-1 Summary of Accident/illness Reporting and Recordkeeping Requirements...18-H-1

Synopsis This procedure establishes requirements and responsibilities for investigating and recording all occupational injuries, illnesses, equipment/property damage, motor vehicle and near-miss accidents and incidents. The procedure complies with the requirements of 29 CFR 1904, "Recording and Reporting Occupational Injuries and Illnesses" and 29 CFR 1960 Subpart I, "Record Keeping and Reporting Requirements for Federal Employees" and NAO 209-1 NOAA Safety Policy. This procedure applies to all NWS facilities, work locations and employees. Initial Implementation Requirements: Analyze Site Operations versus Requirements of the Procedure Develop/Obtain Documentation/Information required for Site - Ensure that all accidents including near misses are reported by supervisors via the NOAA Web Based Safety Incident Reporting System (18.3.1.a) - Ensure all accidents are fully investigated (18.3.3) - Ensure availability of required accident/illness reporting forms CA-1, CA-2, SF-91, SF-94, etc. (Attachments B-G, OPS1 web site: https://www.ops1.nws.noaa.gov/secure/safety/ehb- 15/Procedures_final/accident_reporting.htm or the OPS1 website https://www.ops1.nws.noaa.gov/secure/safety/workerscomp.html - Workers Compensation page). Provide Local Training of Site Personnel Personnel Awareness Training Recurring and Annual Task Requirements: Review/Update Documentation/Information required for Site - Maintain records related to incidents and unsafe conditions for 5 years (18.3.6) - Post annual summary of occupational incidents and illnesses (18.3.6) Perform Occupational Injuries Investigation/Corrective Action Determination Provide Refresher Training of Site Personnel (If Applicable) 18 ii

Accident/illness Reporting and Recording Checklist Requirements Reference YES NO N/A Comments Is initial and annual review of this procedure conducted and documented? Are all employees and supervisors aware of web based safety incident/accident reporting procedures? Do employees report to their supervisors upon return to work from an occupational accident or illness? Are required worker s compensation forms available for site personnel use? Are all safety incidents/accidents and near misses investigated and corrective actions taken to preclude recurrence of similar incidents? Are employees encouraged to orally report unsafe/unhealthful working conditions or use Form CD-351, if necessary? Are Forms SF-91, SF-94, used to report motor vehicle related incidents? Are they readily available in vehicle glove compartments? Is a copy of annual site specific summary of occupational injuries and illnesses (Log 300A) posted from February 1 to April 30? 18.4.2 18.3.1 18.3.1c 18.3.2 Attachments B-G 18.3.3 18.3.5 18.3.4 18.3.6c 18 iii

18 ACCIDENT/ILLNESS REPORTING AND RECORDING 18.1 Purpose and Scope As part of its goal to provide a safe and healthful workplace, the National Weather Service (NWS) has established requirements and responsibilities for the investigation and recording of all occupational injuries, illnesses, equipment/property damage, motor vehicle and near-miss accidents and incidents to comply with the requirements of 29 CFR 1904, Recording and Reporting Occupational Injuries and Illnesses and 29 CFR 1960 Subpart I, Record Keeping and Reporting Requirements for Federal Employees. This procedure applies to all NWS facilities, work locations and employees. 18.2 Definitions Accident/Incident. An unexpected, unplanned, unwanted event or occurrence which either results in personal injury/illness and/or property damage. Employee. Any person employed or otherwise permitted, or required to work by the NWS. Field Office. A Field Office may include the following: Weather Forecast Office (WFO), River Forecast Center (RFC), Weather Service Office (WSO), and a Data Collection Office (DCO). Near Miss. An accident/incident which does not result in personal injury/illness and/or property damage but had the potential to do so and/or a situation in which an inappropriate action occurs or necessary action is omitted, but is detected and corrected before an adverse effect on personnel or equipment results. Occupational Illness. Any abnormal physical conditions or disorders other than one resulting from an occupational injury caused by exposure to environmental factors which are associated with employment. Occupational Injury. Any injury such as a cut, fracture, sprain, amputation, etc. which results from a work accident or from a single instantaneous exposure in the work environment. Operating Unit. For the purpose of this procedure, Operating Unit includes the National Centers for Environmental Prediction (NCEP), National Data Buoy Center (NDBC), NWS Training Center (NWSTC), National Reconditioning Center (NRC), Radar Operations Center (ROC), or the Sterling Field Support Center (SFSC). OSHA Recordable Injury or Illness. All work-related fatalities, illnesses and those related injuries which result in loss of consciousness, restriction of work or motion, transfer to another job or required medical treatment beyond first aid. NOAA SECO. NOAA Safety and Environmental Compliance Office. 18 1

Station Manager. For the purpose of this procedure, the Station Manager shall be either the NWS Regional Director; Directors of Centers under NCEP (Aviation Weather Center, NP6; Storm Prediction Center, NP7; and Tropical Prediction Center, NP8; Space Weather Prediction Center, NP9); Directors of the NDBC, NWSTC, and Chiefs of NRC, ROC and SFSC facilities; or Meteorologist in Charge (MIC), Hydrologist in Charge (HIC), or Official in Charge (OIC) 18.3 Procedure 18.3.1 Safety Incident/Accident Reporting When a safety incident/accident occurs, the first priorities are to ensure that the work area is safe in order to prevent injuries to additional personnel and to provide prompt medical assistance to the injured. The affected employee shall immediately report the incident to his/her supervisor. Employees should seek initial treatment for work related illness or injury at health units where available. All job-related safety incidents/accidents, illnesses, near-misses, and property damage/loss must be reported. Any delay in reporting an accident may slow the compensation process. Reporting of near-miss incidents can prevent future occurrences. a. All incidents must be reported within 24 hours of occurrence. If the incident is of a serious nature, the reports must be made within 8 hours. A serious incident involves 3 or more hospitalizations, fatality, or property damage or loss exceeding $1 million. The NOAA Web-based Accident/Illness Reporting System will be used to report all safety incidents/accidents and near misses involving NOAA employees, contractors, and NOAA property. The web site can be accessed via Internet Explorer at: - https://ops13web.nws.noaa.gov/accgen/acc_form.info_scn Only NWS supervisory personnel will enter information into the NOAA web-based Accident/Illness Reporting System. If there is not enough information at the time of report completion, a Follow-Up Information Report (available on the web site) should be filled out as soon as information becomes available. Incidents include accidents with and without injury (near-miss incidents); all driving accidents while on government business; all property losses including those from fire, ship damage, or environmental spills; and any other incident that results in property damage. Incidents also include any work related illnesses which may involve exposure to chemical, physical (noise, radiation) and biological (bacterial, viral) agents. b. Paper Form CD-137 Report of Injury, Illness, Accident, or Fatality is no longer required and has been replaced by web-based report. c. Prior returning to work from an occupational injury, accident, or illness, employees will advise supervisors of their return to work status and of any restrictions or conditions for work. 18 2

18.3.2 Workers Compensation Many NWS incidents involve treatment by a private physician or an emergency room. NOAA uses the Federal Employees Compensation Act (called Workers' Compensation for short) to pay for these services. All Department of Commerce (DOC) workers compensation claims processing and liaison services have been provided by a commercial vendor. To ensure timely claims submission, supervisors shall send all initial claims (CA-1's and CA-2's), CA-16 (see Note below), and claims for disability compensation (CA-7's) to the Worker s Compensation contractor. The address and contact information can be found at: https://www.ops1.nws.noaa.gov/secure/safety/workerscomp.html. More information about the DOC Workers Compensation Program, the Department of Labor Office of Workers Compensation Program, and electronic forms can be found at OPS1 web site: https://www.ops1.nws.noaa.gov/secure/safety/ehb- 15/Procedures_final/accident_reporting.htm and NOAA SECO web site: https://sites.google.com/a/noaa.gov/seco/safety-oh-homepage-1/workers-compensation Attachment H to this manual contains a summary of Accident/illness Reporting and Recordkeeping Requirements. NOTE: CA-16 should be issued when employee needs to seek prompt medical care related to injury. In most instances, a supervisor should consult with NOAA s Workers Compensation contractor, prior to the issuance of the CA-16. The contractor can help the supervisor determine if a CA-16 is warranted based on the facts related to the injury and provide guidance if additional forms are required. 18.3.3 Incident/Accident Investigation Each accident, including near misses, must be investigated to: Prevent a recurrence. Accident investigation often brings out hidden safety issues that need to be addressed; Determine a cause. Determining the cause is not placing blame. Usually accidents have multiple causes and contributing factors; Document events and allow proper management of workers compensation claims; and Meet legal requirements for reporting to the Occupational Safety and Health Administration (OSHA). Requirements for investigation of safety incidents are set by the accident class. Specific information on the incident reporting, reporting and analysis can be found in NOAA Incident Reporting, Recording, and Analysis Manual posted at NOAA SECO web site: https://sites.google.com/a/noaa.gov/seco/safety-oh-homepage-1. The immediate cause of an accident is often operational practices or conditions. Examples of operational practices are: operating without authority, using equipment improperly, not using personal protective equipment when required, not using correct lifting techniques, alcohol or 18 3

drug use, horseplay, and not properly securing equipment. Examples of conditions are: unserviceable tools and equipment, inadequate warning systems or instructions, bad housekeeping practices, poorly lit work spaces, and unhealthy work environment. 18.3.4 Accident/Incident Resulting in Equipment/Property/Motor Vehicle Damage All accidents/incidents causing equipment, property, or motor vehicle damage shall be reported on the NOAA Web-based Accident/Illness reporting system as soon as possible. This includes GSA owned, leased, or rented vehicles used by NWS employees; personally owned vehicles if on official duty; and vehicles used by contractors during government related travel. Drivers must report all accidents involving these vehicles within 24 hours and 8 hours if the accident is serious. Any vehicle accident on public roads shall be investigated by police if feasible. Drivers and supervisors should make every attempt to obtain copies of any police reports. Employee injuries must also be reported using the guidelines outlined in 18.3.1 Safety Incident/Accident Reporting. Contractor injuries must be reported by company employees to the contractor s insurance company. Form SF-91 Operator s Report of Motor Vehicle Accident Report (Attachment E) and, if appropriate, Form SF-94 Statement of Witness (Attachment F) must be completed. Form SF- 94 may be used to record witness identity and accident/illness information. Copies of the SF-91, SF-94, vehicle repair estimates, and police reports (if available) must be faxed to the DOC Office of General Counsel (202-482-5858). This allows damage to civilian vehicles or property to be adjudicated. The following steps should be followed if you are involved in an accident: a. Stop immediately. b. Take steps to prevent another accident at the scene. c. Call a doctor or ambulance if necessary. d. Notify the police. e. Do not sign any paper or make any statement as to who was at fault (except to your supervisor or to a Federal government investigator). f. Get the name and address of each witness. Ask each witness to complete Standard Form 94, Statement of Witness, in the Accident reporting kit (located in the glove compartment). g. Give the police your name, address, place of employment, and name of your supervisor. Upon request, show your operator's permit and vehicle registration card. (NOTE: Only government-owned or leased vehicles registered in the District of Columbia or displaying state tags have registration cards.) h. Complete Standard Form 91, Motor Vehicle Accident Report. Notify the Dispatch Pool Manager as soon as possible by calling the telephone number(s) listed in the vehicle's Log Book. i. If you are unable to reach the Dispatch Pool Manager, call the GSA Maintenance Control Center (888-622-6344). j. If the vehicle is unsafe to drive and you are unable to contact the Dispatch Pool 18 4

Manager or the GSA Maintenance Control Center (e.g., due to an accident after normal duty hours) have it towed to the nearest repair shop and contact the Dispatch Pool Manager as soon as possible. 18.3.5 Unsafe /Unhealthful Working Conditions Reporting a. Employees are encouraged to orally report unsafe or unhealthful work conditions to their immediate supervisor who shall promptly investigate the situation and take appropriate corrective actions. NOTE: Per NAO 209-1, NOAA Safety Policy (4/30/09), employees are responsible to promptly report all unsafe conditions and safety incidents to their immediate supervisor. NAO 209-1 also states that employees have the right to decline to perform their assigned task because of a reasonable belief that the task or situation poses an imminent risk of death or serious bodily harm, and that there is insufficient time to reduce the risk through normal hazard reporting and abatement procedures. b. Supervisors may contact NWS personnel with authority to correct the unsafe/unhealthful working condition, if required. NWS Regional or Operating Unit Environmental/Safety Coordinator and NWSH safety staff may also be contacted for assistance. c. If employee does not wish to notify supervisor for personal reasons or supervisor fails to take a corrective action within a reasonable time frame, the employee may submit a written report of unsafe/unhealthful working conditions (Form CD-351). Regional or Operating Unit chain of command should be followed for CD-351 submittal (See Attachment B). If issue is not resolved at Regional or Operating Unit level, the employee can contact NWSH and NOAA SECO safety personnel for assistance. d. The CD-351 shall provide a detailed description of the unsafe/unhealthful working condition, including but not limited to the following: the date when the condition was first observed; name(s) and/or job title(s) of personnel to whom the request to address the unsafe/unhealthful condition was submitted and when; outcome of requests for resolution; NWS personnel impacted; any interim measures taken to protect employees (e.g., administrative, engineering, PPE), etc. e. If unsafe/unhealthful working condition is related to a specific NWS Program (e.g., NWR, Upper Air, NEXRAD, etc.) and does not present potentially serious hazard or imminent danger, it should be coordinated with appropriate Regional Program Managers first. NOTE: The CD-351 can also be prepared by Regional Headquarters personnel for unsafe/unhealthful working conditions impacting all or majority of NWS offices in that Region. The same CD-351 form that is used by individual offices can be used. The Regional CD-351 will be submitted to NWSH for review and evaluation. All remaining Regions will be also involved in review in order to determine if similar working conditions are present at their respective offices. 18 5

f. A person who receives CD-351 shall contact originator of report, if possible, to acknowledge its receipt and discuss the seriousness of the reported unsafe/unhealthful working condition. Supervisor shall be informed about the CD-351 submitted. g. Imminent danger situations reported shall be investigated within 24 hours. h. Potentially serious situations shall be investigated within 3 days. i. If the reported working condition involves a health hazard, the assistance of a competent industrial hygienist shall be requested. j. The person who received CD-351 must provide a written interim or complete response to the originator of the report within 15 working days of receipt. Interim reports should include the expected date for a complete response. k. The complete response shall indicate the appropriate channels available for formal appeal (see Chapter 10, paragraph 03 of DOC Safety Manual for additional information related to appeals). l. Employees involved in a near miss shall report the incident to their supervisor(s) who shall investigate it immediately and report it in NOAA Web-based Accident/Illness Reporting System. m. The records related to unsafe or unhealthful working conditions or near-miss incidents shall be maintained for five years. 18.3.6 Recording and Recordkeeping a. All safety incidents/accidents are recorded in the NOAA Web-based Accident/Illness reporting system by supervisors and in the Microsoft Excel NOAA Safety Information Reporting System (SIRS) by NOAA SECO. An accident report is e-mailed to respective manager(s) on the next day (same day for serious accidents) by NOAA Web-based Accident/Illness reporting system. A cumulative monthly accident report is provided to respective Regional Directors, Operating Unit Directors, and the Deputy Assistant Administrator by NWS Headquarters (NWSH). This monthly report includes OSHA recordable injuries/illnesses rates as well as lost time rates for each Region/Operating Unit. NOTE: Privacy Case, instead of name, must be entered in web-based reporting system for Bloodborne Pathogens exposure incidents. Exposure Incident Report (see Chapter 33, Bloodborne Pathogens) will be kept as a confidential file (under lock and key). The web-based report number will be referenced on the paper Exposure Incident Report, so that supplemental information can be added to the reporting system, as necessary. b. OSHA Log 300 Log of Work-Related Injuries shall be completed by Station Manager or his/her designee for a calendar year and can be filled any time when accident/incident is processed by NOAA SECO and shown on the NWSH monthly accident report. This Log includes names of employees and should be handled as confidential information. 18 6

NOTE: Employee s name will not be entered on the OSHA 300 Injury and Illness Log in the case where an employee develops a bloodborne disease from an occupational exposure (HIV, Hepatitis B, Hepatitis C) or receives a needlestick injury or cut from a sharp object contaminated by human blood or OPIM. Where the name would otherwise appear on the log, the words privacy case will be entered. A separate, confidential list of case numbers and employee names is maintained. c. Log 300A Summary of Work-Related Injuries and Illnesses shall be prepared to record incidents/illnesses for a calendar year by Station Manager or his/her designee. This Log does not include names of employees. It shall be signed by the manager and posted from February 1 to April 30 of the year following the calendar year covered by the summary in a conspicuous place or places where notices to employees are customarily posted. If there were no incident/accidents at the site, the OSHA Log 300A should still be posted with None in the incident description block. This Log must be maintained on site and for at least five years. It is also recommended that Regional and Operating Unit Environmental and Safety Coordinators maintained copies of the Log 300A prepared by field offices. 18.4 Responsibilities 18.4.1 Regional and Operating Unit Environmental/Safety Coordinators a. Will monitor and promote compliance with the requirements of this procedure at field offices or Operating Unit facilities. b. Will ensure that applicable procedures are implemented at regional headquarters or Operating Unit facilities. 18.4.2 Station Manager a. Will have oversight over the implementation of this procedure, and ensure that the requirements of this procedure are followed by individuals at the NWS facility. b. Will ensure that annual Log 300 is maintained and Log 300A is posted in accordance with 18.3.6. c. Will assure that all accidents/incidents resulted in injury/illness are reported and investigated by supervisors or other designated/authorized personnel. d. Will review, or delegate review, of this procedure on an annual basis to ensure that the facility is complying with its requirements. Confirmation of this review shall be forwarded to the Regional or Operating Unit Environmental/Safety Coordinator. 18 7

18.4.3 NWS Headquarters (NWSH) a. The NWS Safety Office will provide assistance to Regional Headquarters, Operating Units, and field personnel to ensure that NWS facilities comply with requirements of this procedure. b. NWSH will coordinate with NOAA SECO, as necessary, regarding compliance issues related to this procedure. 18.4.4 Supervisor a. Will complete Form CA-1, Federal Employees Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation items 17 through 38, and obtain witness information (if appropriate, item 16) for completion of Items 17 through 20 (See Attachment C). b. Will complete Form CA-2, Notice of Occupational Disease and Claim for Compensation items 19 through 35 (See Attachment D). NOTE: Completed Forms CA-1 and CA-2, will be sent to the address on the website https://www.ops1.nws.noaa.gov/secure/safety/workerscomp.html. c. Will complete and sign Part A of Form CA-16 Authorization for Examination and/or Treatment (See Attachment G). d. Will assure that all accidents/incidents resulted in injury/illness or property damage/loss as well as near miss incidents are reported in NOAA Web-based Accident/Illness Reporting System. 18.4.5 Safety or Environmental/Safety Focal Point a. Will ensure that any responsibilities delegated to them by the Station Manager are implemented in accordance with the requirements of this procedure. b. Will assist in the investigation, information-gathering, and recording of all illnesses/ accidents and incidents, as requested by the Station Managers. 18.4.6 Employees a. Individual employees affected by this procedure are required to read, understand and comply with the requirements of this procedure. b. Employees will report unsafe or unhealthful conditions and practices to their supervisor or safety or environmental/safety focal point. Employees who choose to submit Form CD-351 will complete items 1 through 8 of the form. Completed form will be submitted to the Regional or Operating Unit Environmental/Safety Coordinator. The Environmental/Safety Coordinator can get assistance from NOAA SECO personnel, if necessary. c. Employees will complete items 1 through 15 of Form CA-1 and items 1 through 18 of Form CA-2. Completed forms will be submitted to the supervisor within six days. d. Employees will provide information about medical facility or Physician s office to 18 8

personnel designated/authorized to complete the Form CA-16, before medical treatment can be obtained (if employee is cognizant and not in a life threatening situation). NOTE: - Reference NWS PD 50-11 for complete list of responsibilities http://www.weather.gov/directives/050/pd05011c.pdf 18.5 References Incorporated References. The following list of references is incorporated as a whole or in part into this procedure. These references can provide additional explanation or guidance for the implementation of this procedure. 18.5.1 U.S. Department of Commerce, Department Administrative Orders Series, Chapter 9, Safety. 18.5.2 US. Department of Commerce Occupational Safety and Health Manual, July 1997, Chapter 11. 18.5.3 U.S. Department of Labor, Occupational Safety and Health Administration, 29 CFR 1904, Recording and Reporting Occupational Injuries and Illnesses. 18.5.4 U.S. Department of Labor, Occupational Safety and Health Administration, 29 CFR 1960, Subpart I: Record Keeping and Reporting Requirements for Federal Employees. 18.5.5 U.S. Department of Labor Reporting Forms: http://www.dol.gov/esa/regs/compliance/owcp/forms.htm U.S. Department of Labor, Division of Federal Employees' Compensation Home Page: http://www.dol.gov/esa/regs/compliance/owcp/fecacont.htm U.S. Department of Commerce, Office of Human Resource Management: http://hr.commerce.gov/employees/worklifeissues/dev01_006096 18.6 Attachments Attachment A: Safety Incident Rating Details Attachment B: U.S. Department of Commerce Form CD-351 Report of Possible Safety/Health Hazard Attachment C: U.S. Department of Labor Form CA-1 Federal Employees Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation Attachment D: U.S. Department of Labor Form CA-2 Notice of Occupational Disease and Claim for Compensation Attachment E: U.S. Department of Labor Form SF-91 Operator s Report of Motor Vehicle Accident Attachment F: U.S. Department of Labor Form SF-94 Statement of Witness Attachment G: U.S. Department of Labor Form CA-16 Authorization for Examination and/or Treatment 18 9

Attachment H: Summary of Accident/Illness Reporting and Recordkeeping Requirements 18 10

ATTACHMENT A Safety Incident Rating Details Description 18 A-1

Class A Mishap Class B Mishap Class C Mishap NWSM 50-1115 JULY 16, 2014 Incident Rating Details Description Chart Injury to Incident resulting in a fatality. individuals Incident requiring 3 or more personnel in-patient hospitalization within 30 days from date of the incident. Incident resulting in permanent disability as defined by OWCP. Dollar loss Property damage or loss estimated at greater than $1,000,000. Environmental Release of a listed environmental pollutant in a quantity greater than or equal to the chemicals Reportable Quantity ( RQ). damage Release of an environmental pollutant outside of the boundaries of a NOAA Facility that requires notification and a clean-up response in accordance with applicable regulations. Other Any incident involving international activities or participation of foreign government agencies or any other US Agencies. Close call or near miss incidents involving conditions that caused an imminent and severe threat of serious injury to employees or the environment. Any incident elevated from a Class B Incident due to concerns by the investigation authority. Injury to Any incident which results in an in-patient hospitalization of personnel. individuals Injuries which result in five or more consecutive lost work days immediately following the incident. Incident resulting in permanent partial disability as defined by OWCP. Illness, upon the report of treatment, filing a CA-2, or a report of a suspect illness that will trigger further study. Dollar loss Property damage or loss estimated at greater than $20,000 but less than $1,000,000. Environmental Release of an environmental pollutant approaching the Reportable Quantity (RQ). damage Other Injury to individuals Any Aircraft related incident that forces grounding of the aircraft. Loss of vessel while underway regardless of size that does not result in a Class A Mishap. Close call or near miss incidents of NOAA-wide significance reported via NOAA Web-based Incident Reporting System. Any incident elevated from a Class C Incident due to concerns by the investigation authority. Any incident which causes an injury. Incidents which involve first aid or medical treatment. Incidents which result in an employee being taken to a hospital emergency room, without requiring an in-patient stay. Dollar loss Property damage or loss up to $20,000. Environmental Unintentional releases of materials to the secondary containment. damage Other Incidents involving contamination of personnel or environmental exposure by a potentially harmful substance; with no symptoms or circumstances that trigger any other incident classification. Incidents or exposures that have caused concerns to NOAA employees or affiliates to include near miss incidents of local significance reported via NOAA Web-based Incident Reporting System. All motor vehicle incidents (incidents that result in injuries may elevate to Class A or B.) 18 A-2

ATTACHMENT B Form CD-351 Report of Possible Safety/Health Hazard 18 B 1

18 B 2 NWSM 50-1115 JULY 16, 2014

ATTACHMENT C Form CA-1 Federal Employees Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation 18 C 1

18 C 2 NWSM 50-1115 JULY 16, 2014

18 C 3 NWSM 50-1115 JULY 16, 2014